The relationship between markers of malnutrition and muscle wasting with frailty and physical function in older care home residents

Background: Older care homes residents may suffer from malnutrition and muscle wasting within a background of varying degrees of frailty, comorbidity and disability. Hence, malnutrition is complicated by co-presence of sarcopenia, cachexia and inactivity-induced muscle atrophy. Objectives: (1) to assess the prevalence of malnutrition in care home residents using different methodologies. (2) To examine the relationship between measurements of nutritional status and muscle mass with frailty and physical function; Design: initial pilot study. Setting: care homes for older people. Participants: 73 participants, 46 female and 27 male; Intervention: observational study. Measurements: height (m), weight (kg), body mass index (BMI) (kg), bioelectrical impedance assessment (BIA) of fat free mass index (FFMI) (kg/m2), mid upper arm muscle circumference (MUAMC) (cm), Edmonton Frailty Scale (EFS) and Barthel Index (BI). Results: There was a relatively high prevalence of malnutrition depending on measure used. MNA-SF 0-7 score was 30% for females and 28% males. Low MUAMC was found in 41% females and 53% males; low BIA FFMI in 37% females and 52% males. Good correlation (P<0.001) was found for most measures including against EFS and BI for MNA-SF and MUAMC. Conclusions: Malnutrition prevalence was relatively high. MNA-SF and MUAMC correlated well with functional status and frailty EFS measures. FFMI by BIA correlated well with MNA-SF and MUAMC. This range of practical techniques should be explored further for determining malnutrition risk and muscle wasting in relation to functionality and frailty in care home residents

Body mass index mortality paradox in chronic kidney disease patients with suspected cardiac chest pain

Background: Chronic kidney disease (CKD) is a silent clinical condition associated with adverse comorbidity and high cardiovascular disease (CVD) risk. An inverse relationship with body mass index (BMI) and mortality has been demonstrated in hemodialysis patients. However, it is unclear if this risk‐factor paradox is evident in non‐dialysis CKD patients. The aims of this study were to explore the relationship between, nutritional status, markers of inflammation, autonomic and cardiac function with BMI. Longitudinal follow‐up explored the relationship between BMI and allcause mortality. Methods: 211‐consecutive CKD patients referred for dobutamine stress echocardiography to detect or exclude myocardial ischemia were recruited. BMI, albumin, C‐reactive protein (CRP) and haemoglobin (Hb) were recorded as markers of nutritional and inflammatory status. Left ventricular ejection fraction (LVEF) and heart rate variability (HRV) as an indicator of cardiac function was recorded. All subjects were followed prospectively until November 2014 and study end‐point was all‐cause mortality. Results: BMI was inversely associated with CKD status. After covariate adjustment, this association remained. During a mean follow‐up period of 3.3±0.9 years there were 35 deaths (17%). BMI was inversely associated with all‐cause mortality (HR 0.81, 95% CI 0.71‐0.9). Other important independent predictors of mortality were heart rate variability (HR 0.98, 95% CI 0.97‐0.99), myocardial ischemia (HR 1.37, 95% CI 1.17‐1.81), and albumin (HR 0.86, 95% CI 0.81‐ 0.92). Conclusions: The presence of a BMI paradox exists in non‐dialysis CKD patients. This risk‐factor paradox was an independent predictor of all‐cause mortality and may have significant clinical implications relevant to screening, assessment and treatment and requires further study

Screening Tests for Sarcopenia in Patients with Chronic Kidney Disease

Background: Patients with chronic kidney disease (CKD) are at increased risk of muscle wasting. Screening tools for sarcopenia, including the Sarc-F questionnaire are now advocated for clinical practice. We wished to compare using the Sarc-F tool with standard measurements of hand grip (HGS) strength and appendicular muscle mass index (APMI). Methods: We retrospectively reviewed Sarc-F questionnaires completed by patients with CKD, along with contemporaneous measurements of HGS and bioimpedance measured APMI. Results: 146 patients; 94 male (64.4%), mean age 70.5 ± 15 years, body mass index 28.7 ± 6.3 kg/m2 were screened, and 46 screened positive for sarcopenia, with a lower median HGS (19.3 (14.2–24.7) vs 25.6 (19.7–32) kg) and greater body fat (38.3 ± 11.5 vs 30.6 ± 11.5%), both p < 0.001,, with more non-white ethnicity (63 vs 44%), p < 0.05, but there were no other differences. Step-wise adding HGS, and then APMI cut offs, the prevalence of sarcopenia fell from 31.5% to 20.7–24.7% and 2.8–4.8% respectively, with 45.5–62.8% having reduced HGS strength and 11.0–28.1% reduced APMI, depending on which guidelines were applied. Using the most recent European, and ethnicity adjusted cut-off values then there were no statistical differences in the prevalence of sarcopenia with or without the Sarc-F screening tool. Conclusions: By starting with the Sarc-F screening tool, a number of our patients with CKD would then have been excluded from subsequent investigation for sarcopenia. However, overall screening with the Sarc-F tool did not lead to a significant difference in the prevalence of sarcopenia, when using current and ethnicity adjusted guidelines, compared to combining HGS and APMI alone

Body composition and weakness of hand grip strength and pinch strength in patients with chronic kidney disease from different ethnic backgrounds

Background: Chronic kidney disease (CKD) patients commonly report muscle weakness and fatigue. Losing muscle mass increases mortality. Accordingly, we aimed to determine the main factors associated with loss of muscle mass and muscle weakness. Methods: Anthropometric measurements were made in CKD patients attending a specialised clinic, along with hand grip strength (HGS), pinch strength (PS) and body composition (muscle mass and fat mass), using segmental bioimpedance assessment. Results: We reviewed the results of 161 CKD patients; 105 male (65.2%), mean (SD) age 70.3 (15) years, body mass index (BMI) 28.8 (6.7) kg m−2. In multivariable models, both HGS and PS were independently negatively associated with age [standardised β (St β) = 0.35; 95% confidence limits (CL) = −0.32 to −0.14; St β = 0.38; 95% CL = −0.65 to −0.02; P < 0.001, respectively] and positively with appendicular muscle in the arm tested [St β = 0.34; 95% CL = 2.5–6.3; St β = 0.24; 95% CL = 0.17–0.98; P < 0.001 and P = 0.006, respectively]. In addition, HGS was associated with male gender (St β = 0.19; 95% CL = 0.7–7.5; P = 0.019] and negatively with percentage body fat (St β = 0.22; 95% CL = −0.36 to −0.07; P = 0.003]. There were 47 (29.2%) Asian patients who had lower total skeletal muscle mass/height ratio and appendicular muscle mass/BMI ratio compared to other ethnicities [9.6 (1.8) versus 10.5 (1.6) kg m−2, P < 0.01; 0.73 (0.23) versus 0.83 (0.33) m2; P < 0.01). Conclusions: In CKD patients, we found that muscle weakness measured by HGS and PS was associated with increasing age and loss of appendicular muscle mass. HGS was also weaker with increasing fat mass and female gender, whereas PS was weaker in patients of Asian ethnicity

The VLA Low-frequency Sky Survey

The Very Large Array (VLA) Low-frequency Sky Survey (VLSS) has imaged 95% of the 3*pi sr of sky north of declination = -30 degrees at a frequency of 74 MHz (4 meter wavelength). The resolution is 80" (FWHM) throughout, and the typical RMS noise level is ~0.1 Jy/beam. The typical point-source detection limit is 0.7 Jy/beam and so far nearly 70,000 sources have been catalogued. This survey used the 74 MHz system added to the VLA in 1998. It required new imaging algorithms to remove the large ionospheric distortions at this very low frequency throughout the entire ~11.9 degree field of view. This paper describes the observation and data reduction methods used for the VLSS and presents the survey images and source catalog. All of the calibrated images and the source catalog are available online (http://lwa.nrl.navy.mil/VLSS) for use by the astronomical community.Comment: 53 pages, including 3 tables and 15 figures. Has been accepted for publication in the Astronomical Journa

The Origin of Radio Emission in Low-Luminosity Active Galactic Nuclei: Jets, Accretion Flows, or Both?

The low-luminosity active galactic nuclei in NGC 3147, NGC 4203, and NGC 4579 have been imaged at four frequencies with the Very Long Baseline Array. The galaxies are unresolved at all frequencies, with size upper limits of $10^3-10^4$ times the Schwarzschild radii of their central massive black holes. The spectral indices between 1.7 and 5.0 GHz range from 0.2 to 0.4; one and possibly two of the galaxies show spectral turnovers between 5.0 and 8.4 GHz. The high brightness temperatures ($> 10^9$ K) and relatively straight spectra imply that free-free emission and/or absorption cannot account for the slightly inverted spectra. Although the radio properties of the cores superficially resemble predictions for advection-dominated accretion flows, the radio luminosities are too high compared to the X-ray luminosities. We suggest that the bulk of the radio emission is generated by a compact radio jet, which may coexist with a low radiative efficiency accretion flow.Comment: To appear in ApJ (Letters). 4 page

Sarcopenic Obesity and Depression: A Systematic Review

BACKGROUND: Sarcopenic obesity (SO) is a condition combining two important public health issues commonly seen amongst older individuals, obesity and sarcopenia. Depressive symptoms are common among older people, whose population is increasing worldwide. Obesity and sarcopenia alone, are clearly associated with depression while the coexistence of these two conditions (SO) upon depressive disorders is currently unclear. We aimed to systematically review the association between primary SO and depressive disorders. METHODS: Searches were run on MEDLINE, EMBASE, PsycINFO, and CINAHL (inception to June 2019). One reviewer screened titles, abstracts, and full-texts, with 10% checked independently by a second reviewer. Cohort and cross-sectional studies were included. Two reviewers independently assessed risk of bias using the Mixed Methods Appraisal Tool. Results were narratively synthesised. RESULTS: Out of the 7 studies eligible for inclusion, evidence of sarcopenic obesity as a predictor of depressive symptoms was found in two studies. The main observed trend was that diagnosing sarcopenia using muscle strength led to significant associations between sarcopenic obesity and depressive symptoms. Two cross-sectional studies found a significant association between SO and depressive symptoms, whilst three others found no statistically significant associations. All possessed some methodological limitations. DISCUSSION: This is the first review to systematically examine a potential relationship between sarcopenic obesity and depressive disorders. Currently, the results are heterogeneous due to the large variability in assessment methods and outcome measurements. Future longitudinal studies would achieve greater confidence in the provisional conclusion that sarcopenic obesity, when measured using muscle strength, is associated with depressive symptoms

Chandra Observations of the Disruption of the Cool Core in Abell 133

We present the analysis of a Chandra observation of the galaxy cluster Abell 133, which has a cooling flow core, a central radio source, and a diffuse, filamentary radio source which has been classified as a radio relic. The X-ray image shows that the core has a complex structure. The most prominent feature is a "tongue" of emission which extends from the central cD galaxy to the northwest and partly overlaps the radio relic. One possibility is that this tongue is produced by Kelvin-Helmholtz (KH) instabilities through the interaction between the cold gas around the cD galaxy and hot intracluster medium. We estimate the critical velocity and time scale for the KH instability to be effective for the cold core around the cD galaxy. We find that the KH instability can disrupt the cold core if the relative velocity is >~400 km s^-1. We compare the results with those of clusters in which sharp, undisrupted cold fronts have been observed; in these clusters, the low temperature gas in their central regions has a more regular distribution. In contrast to Abell 133, these cluster cores have longer timescales for the disruption of the core by the KH instability when they are normalized to the timescale of the cD galaxy motion. Thus, the other cores are less vulnerable to KH instability. Another possible origin of the tongue is that it is gas which has been uplifted by a buoyant bubble of nonthermal plasma that we identify with the observed radio relic. From the position of the bubble and the radio estimate of the age of the relic source, we estimate avelocity of ~700 km s^-1 for the bubble. The structure of the bubble and this velocity are consistent with numerical models for such buoyant bubbles. (abridged)Comment: 38 pages, 15 figures, accepted for publication in Ap